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F L O R I DA C A N C E R DATA S Y S T E M
JULY/AUGUST 2004 MONTHLY
MEMO
HAPPY FOURTH OF JULY
UGI Tract Cancer
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•
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MONTHLY MEMO
•
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INTRODUCTION TO UGI
TRACT CANCER
Collectively, cancers of the
esophagus, stomach, and small
intestine are referred to as
upper gastrointestinal tract
(UGI) cancers. UGI cancers
represent the second most
common site and cause of
death among the digestive
system cancers.
Esophagus Cancer
The American Cancer Society
estimates that during 2003,
approximately 13,900 new
esophageal cancer cases will
be diagnosed in the United
States (10,600 men and
3,300 women). This disease is
about 3 times more common
among men than women and
almost 3 times more common
among African Americans than
whites.
There are two main types of
esophageal cancer: squamous
cell carcinoma and
adenocarcinoma. The majority
of cancers in the upper two
thirds of the esophagus are
squamous cell carcinoma in
nature. Adenocarcinoma starts
in glandular tissue, which
normally does not cover the
esophagus. It usually occurs in
the lower esophagus, near the
stomach. Before an
adenocarcinoma can develop,
glandular cells must replace
an area of squamous cells, for
example as in Barrett
esophagus.
Squamous cell carcinoma is the
most common type of cancer
of the esophagus among
African Americans, while
adenocarcinoma is more
common in whites. Cancer of
the esophagus is much more
common in some regions of the
world. For example,
esophageal cancer rates in
Iran, northern China, India,
and southern Africa are 10 to
100 times higher than in the
United States.
Stomach Cancer
Stomach cancer (also called
gastric cancer) can develop in
any part of the stomach and
may spread throughout the
stomach and to other organs.
It may grow along the
stomach wall into the
esophagus or small intestine. It
also may extend through the
stomach wall and spread to
nearby lymph nodes and to
organs such as the liver,
pancreas, and colon. Stomach
cancer also may spread to
distant organs, such as the
lungs, the lymph nodes above
the collar bone, and the
ovaries. Each year, about
24,000 people in the United
States are diagnosed with
cancer of the stomach.
Most of stomach cancers are
adenocarcinomas, arising in
the glandular cells in the
stomach lining. These
glandular cells normally
produce mucus and digestive
enzymes. Other stomach
cancers may include squamous
cells cancers, lymphomas,
sarcomas, and neuroendocrine
tumors.
Small Intestine Cancer
Cancer of the small intestine, a
rare cancer, is a disease in
which cancer cells are found in
the tissues of the small
intestine. Each year US doctors
diagnose about 1,200
malignant small intestine
tumors. This is a small number
relative to the frequency of
tumors in other parts of the GI
tract.
The majority of cancers of the
small intestine are
adenocarcinomas (50% or
more) and commonly start in
the duodenum, jejunum, and
the part of the small intestine
nearest the stomach. These
cancers often grow and
obstruct the bowel.
Leiomyosarcomas, another
type of small intestine cancer,
(Continued on page 2)
JULY/AUGUST 2004 MONTHLY MEMO
HAPPY FOURTH OF JULY
UGI TRACT CANCER (Cont’d)
Page 2
(Continued from page 1)
ANATOMY
occur most often in the ileum. Some 20% of malignant lesions of
the small intestine are carcinoid tumors, which occur more
frequently in the ileum than in the duodenum or jejunum. It is
uncommon to find malignant lymphoma as a solitary small
intestinal lesion.
Esophagus
FIVE-YEAR SURVIVAL RATES
(from the National Cancer Institute's Physician Data Query
system, July 2003)
The esophagus is a muscular tube about ten inches (25 cm.) long
extending from the hypopharynx to the stomach. The esophagus
lies posterior to the trachea and the heart, and passes through
the mediastinum and the hiatus, an opening in the diaphragm, in
its descent from the thoracic to the abdominal cavity. The
esophagus has no serosal layer; tissue around the esophagus is
called adventitia.
Esophageal cancer is lethal because the esophagus has no
serosa; any tumor extension beyond the esophagus can spread
rapidly. Overall, the five-year survival rate is less than 10% for
all stages combined.
There are two subsite descriptions for the esophagus and they
are not equivalent.
Esophagus
Cervical
Subsite Description 1
Cervical begins at the lower end of pharynx (level of 6th
vertebra or lower border of cricoid cartilage) and extends to the
thoracic inlet (suprasternal notch); 18 cm from incisors.
Stage 0
Excellent
Stage I
> 65%
Stage IIA
30%
Stage IIB
15%
Stage III
< 10%
Stage IV
Rare
Mid thoracic: from tracheal bifuraction
gastroesophageal junction; 24-32 cm.
Stage 0
> 90%
Stage I
50 - 70% for distal cancers; 10 - 15% for
proximal cancers
Lower thoracic: from midway between tracheal bifurcation and
gastroesophageal junction to GE junction, including abdominal
esophagus; 32-40 cm.
Stage II
> 25% for T1/T2 Node positive cases; <
25% for T3 cases
Stage III
15% for distal cancers
Stage IV
< 5%
Stomach
Small Intestine
Stage 0
not reported
Stage I
60-70%
Stage II
45-55%
Stage III
15%
Stage IV
<10%
Carcinoid
< 40%
Thoracic
Upper thoracic: from thoracic inlet to level of tracheal
bifurcation; 18-23 cm.
midway
to
Abdominal
Considered part of lower thoracic esophagus; 32-40 cm.
Subsite Description 2
Upper third (10% of esophageal cancers)
Middle third (40%)
Lower third (50%)
The figure below illustrates the correlation between subsite
descriptions of the esophagus.
(Continued on page 3)
JULY/AUGUST 2004 MONTHLY MEMO
UGI TRACT CANCER (Cont’d)
Page 3
(Continued from page 2)
HAPPY FOURTH OF JULY
The figure below shows the anatomy of
the stomach.
Anatomy of the Small Intestine
Stomach
The stomach lies just below the
diaphragm in the upper part of the
abdominal cavity primarily to the left of
the midline under a portion of the liver.
The main divisions of the stomach are the
following:
Cardia
The cardia is the portion of the stomach
surrounding the cardioesophageal
junction, or cardiac orifice (the opening of
the esophagus into the stomach). Tumors
of the cardioesophageal junction are
usually coded to stomach.
Fundus
The fundus is the enlarged portion to the
left and above the cardiac orifice.
Body
The body, or corpus, is the central part of
the stomach.
Pyloric antrum
The pyloric antrum is the lower or distal
portion above the duodenum. The
opening between the stomach and the
small intestine is the pylorus, and the very
powerful sphincter which regulates the
passage of chyme into the duodenum is
called the pyloric sphincter.
The stomach is suspended from the
abdominal wall by the lesser omentum.
The greater omentum attaches the
stomach to the transverse colon, spleen
and diaphragm.
The common mesentery suspends the small
intestine. The parietal peritoneum lies
over the duodenum and other structures,
such as the abdominal aorta. Because
they lie behind the peritoneum, they are
called retroperitoneal structures.
Layers of UGI Organs
1. Body of stomach
2. Fundus
3. Anterior wall
4. Greater curvature
5. Lesser curvature
6. Cardia
9. Pyloric sphincter
10. Pyloric antrum
11. Pyloric canal
12. Angular notch
13. Gastric Canal
14. Rugal folds
Small Intestine
The small intestine is a tube measuring
about 2.5 cm in diameter. The complete
small intestine is approximately 600 cm
(20 feet) long and coiled in loops, which
fill most of the abdominal cavity. It
extends from the pyloric sphincter to the
ileocecal valve, where it joins the large
intestine and is comprised of three parts:
Duodenum-- approximately 25 cm long;
proximal end of small intestine; joined to
stomach by the pyloric sphincter.
Jejunum-- approximately 200 cm long.
Ileum-- approximately 300 cm long; joins
the cecum at the ileocecal valve.
Peyer patches-- lymphoid tissue in lamina
propria primarily in distal ileum; primary
site for lymphomas.
Meckel diverticulum--congenital anomaly
of the ileum, a diverticulum analogous to
the appendix of the cecum; a potential
site for malignancy.
Layers of Esophageal Wall
The esophageal wall contains four layers:
• mucosa -- surface epithelium, lamina
propria, and glands
• submucosa -- connective tissue, blood
vessels, and glands
• muscularis (middle layer)
o
upper third, striated muscle
o
middle third, striated and
smooth
o
lower third, smooth muscle
• adventitia -- connective tissue that
merges with connective tissue of
surrounding structures
1. Mucosa
2. Submucosa
3. Muscularis
4. Adventitia
5. Striated muscle
6. Striated and smooth
7. Smooth muscle
8. Laminamuscularis mucosae
9. Esophageal glands
(Continued on page 4)
JULY/AUGUST 2004 MONTHLY MEMO
HAPPY FOURTH OF JULY
UGI TRACT CANCER (Cont’d)
Page 4
(Continued from page 3)
Layers of Stomach Wall
Layers of the stomach wall, among others,
include serosa, muscularis, submucosa,
mucosa. The three layers of smooth muscle
consist of the outer longitudinal, the
middle circular, and the inner oblique
muscles. Construction of these muscles
helps mix and break the contents into a
suspension of nutrients called chyme and
propels it into the duodenum.
Thoracic (lower):
ICD-O CODES FOR UGI TRACT CANCER
RELATED TERMS AND ADJECTIVES
Left gastric, cardial, perigastric, NOS,
posterior mediastinal, nodes of lesser
curvature
Stomach
Esophagus
esophageal,
esophago-
Inferior (right) gastric:
Stomach
gastric, gastro-
Small intestine
small bowel,
entero-, duodeno-,
jejuno-, ileo-
Greater curvature, greater omental,
gastroduodenal,
gastrocolic,
gastroepiploic (right or NOS),
gastrohepatic, pyloric (including
subpyloric and infrapyloric),
pancreaticoduodenal
Splenic:
Esophagus,
upper
stomach and small gastrointestinal
intestine
(UGI),
esophagogastrod
uodeno-
Gastroepiploic (left), pancreaticolienal,
peripancreatic, splenic hilar
Superior (left) gastric:
1. Serosa
2. Tela subserosa
3. Muscularis
4. Oblique fibers of muscle wall
5. Circular muscle layer
6. Longitudinal muscle layer
7. Submucosa
8. Lamina muscularis Mucosae
9. Mucosa
10. Lamina propria
11. Epithelium
12. Gastric glands
13. Gastric pits
14. Villous folds
15. Gastric areas (gastric surface)
REGIONAL LYMPH NODES
Esophagus
Cervical:
Superior mediastinal, anterior deep
cervical (internal jugular), upper cervical,
periesophageal, supraclavicular, lowest
paratracheal (azygos), cervical NOS
Thoracic (upper and middle):
Internal jugular, tracheobronchial,
peritracheal, perigastric, carinal, hilar,
posterior mediastinal, periesophageal
Lesser curvature, lesser omental,
gastropancreatic (left), gastric (left),
paracardial, cardial, cardioesophageal
ICD-O-3 TERM
Esophagus
C15.0
Cervical esophagus
C15.1
Thoracic esophagus
C15.2
Abdominal esophagus
C15.3
Upper third of
esophagus
C15.4
Hepatic (pancreaticoduodenal,
infrapyloric, gastroduodenal
Middle third of
esophagus
C15.5
Lower third of
esophagus
Jejunum:
C15.8
Overlapping lesion of
esophagus
C15.9
Esophagus, NOS
Perigastric, NOS
Celiac
Hepatic
Small Intestine
Duodenum:
Superior mesenteric
Ileum:
Posterior cecal and ileocolic (for terminal
ileum)
Superior mesenteric
Stomach
C16.0
Cardia, NOS
C16.1
Fundus of stomach
C16.2
Body of stomach
C16.3
Gastric antrum
(Continued on page 6)
JULY/AUGUST 2004 MONTHLY MEMO
HAPPY FOURTH OF JULY
Page 5
DEADLINES AND REMINDERS
PATH LAB REPORTING
Every anatomic pathology laboratory that reads biopsy and surgical resection specimens
collected from patient encounters within the state of Florida MUST electronically submit the
specified data for every malignant cancer case. Specimens read between July 1, 2003 and
December 31, 2003 were due to FCDS on or before June 30, 2004. All 2003 data were due
on June 30, 2004.
January 1, 2004 through June 30, 2004 data are due December 31, 2004.
FCDS Q & A
SEER INQUIRY SYSTEM:
HTTP://SEER.CANCER.GOV/SEERINQUIRY/
References
References
CS Manual, Part II ;pgs 549-551 (Vers 1.0, Jan 1, 2004)
1. CS Manual, Part I ;pgs 27 (Vers 1.0, Jan. 1, 2004)
2. CS Manual, Part II ;pgs 458 (Vers. 1.0, Jan. 1, 2004)
Question
CS extension--Bladder: How would extension be coded for a
bladder case that states: papillary transitional cell carcinoma
with no invasion into the submucosa or deep muscularis. There is
focal extension of tumor into bladder diverticula.
Answer
Assign extension code 01 [Papillary transitional cell carcinoma
stated to be noninvasive]. Extension into bladder diverticula does
not change the code. Diverticula are pouches in the mucosa
(mucous membrane).
Question
CS Tumor Size--Breast: When the diagnosis is inflammatory
carcinoma of the breast, must the CS tumor size always be 998?
Answer
No. For inflammatory carcinoma, code the size of the tumor in CS
tumor size. Use code 998 [diffuse] when the tumor is stated to be
"diffuse."
Page 27 in Part I of the CS manual will be corrected to define
code 998 for breast as only "diffuse." The errata should be
distributed in July 2004.
JULY/AUGUST 2004 MONTHLY MEMO
HAPPY FOURTH OF JULY
UGI TRACT CANCER (Cont’d)
Page 6
(Continued from page 4)
Stomach (Cont’d)
C16.4
Pylorus
C16.5
Lesser curvature of stomach, NOS
(not classifiable to C16.1 to C16.4)
C16.6
Greater curvature of stomach, NOS
(not classifiable to C16.0 to C16.4)
C16.8
Overlapping lesion of stomach
C16.9
Stomach, NOS
Small Intestine
Lymphoma (many morphology codes)
Leiomyosarcoma (88903, 88913, 88963; 1% of all gastric
cancers)
Small Intestine
Adenocarcinoma (81403)
Lymphoma (many morphology codes)
Leiomyosarcoma (88903, 88913, 88963)
Carcinoids (82403, 82413, 82433, 82443)
Synonyms for in situ carcinoma: (adeno)carcinoma in an
adenomatous polyp with no invasion of stalk, confined to
epithelium, noninfiltrating, intraepithelial, involvement up to but
not including the basement membrane, noninvasive, no stromal
involvement, papillary noninfiltrating
EXTENT OF DISEASE FOR UGI CANCER
C17.0
Duodenum
C17.1
Jejunum
C17.2
Ileum (excludes Ileocecal valve C18.0)
COMMON METASTATIC SITES
C17.3
Meckel diverticulum (site of neoplasm)
SPREAD
C17.8
Overlapping lesion of small intestine
LYMPHATIC SPREAD
C17.9
Small intestine, NOS
Most common for esophageal and
stomach cancers; distant lymph
nodes include supraclavicular,
retropancreatic, hepatoduodenal,
aortic, portal, retroperitoneal,
mesenteric and inguinal
INTRACAVITARY SPREAD
From stomach--peritoneal
seeding; also submucosal
extension into esophagus or
duodenum; direct extension into
liver, transverse colon, pancreas
or diaphragm
MORPHOLOGY AND GRADE
If the diagnostic term in the pathology report is not in the
following list, be sure to consult your ICD-O manual.
Esophagus
Squamous cell carcinoma (The majority of cancers in the upper
two thirds of the esophagus are squamous cell carcinoma in
nature. Adenocarcinomas, which also arise in the esophagus, are
more prevalent in the lower third of the esophagus.)
Adenocarcinoma (in Barrett esophagus)
PRMARY SITE/METS
HEMATOGENOUS SPREAD Esophagus--liver, lung, pleura,
kidney;
Stomach--liver, lung, peritoneum,
bone;
Small intestine--liver, lung
Key words: Barrett esophagus--gastric mucosa (glandular)
continuing into esophagus
Stomach
EXTENT OF DISEASE EVALUATION
Adenocarcinoma (81403; 95% of all gastric cancers; subtypes:
ulcerative 70%, polypoid 10%, scirrhous/diffusely spreading/
Linitis plastica 10%, superficially spreading 5%)
DEFINITIONS
Signet ring adenocarcinoma (84903)
Linitis plastica (81423) -- complete involvement of the stomach;
leathery appearance
(Parentheses enclose the names of the organs for which the
diagnostic study is useful.)
Key words/involvement:
Terms which indicate tumor is present. Common terms are
provided, but the list is not all-inclusive.
Krukenberg tumor (84906) -- metastatic signet ring carcinoma in
the ovaries; most likely from stomach or intestinal primary
(Continued on page 7)
JULY/AUGUST 2004 MONTHLY MEMO
HAPPY FOURTH OF JULY
UGI TRACT CANCER (Cont’d)
Page 7
(Continued from page 6)
N1 Regional lymph node metastases
Other words/no involvement:
Other terms seen in reports which indicate an abnormality but
do not indicate tumor is present. Common terms are provided,
but the list is not all-inclusive.
Lower thoracic esophagus
Key information:
Upper thoracic esophagus
Information to look for in the report of the study. Key
information helps define the extent of disease.
M1a Cervical lymph nodes
M1b Other distant metastases
DIAGNOSTIC STUDIES
Mid-thoracic esophagus
•
•
•
•
•
•
•
M1a Not applicable
M1b Non-regional lymph nodes or other distant metastases
PHYSICAL EXAM
LABORATORY TESTS
IMAGING
TUMOR MARKERS
ENDOSCOPIES
OPERATIVE REPORT
PATHOLOGY
UGI CANCER STAGING
Criteria for TNM Clinical Staging:
Physical examination and history; pathologic examination of
biopsy specimen to establish a diagnosis of cancer, endoscopies
and imaging procedures, surgical exploration of primary site.
Criteria for TNM Pathologic Staging:
Examination of surgically resected specimen and lymph nodes.
Notes on TNM Staging for Stomach
Tumor that involves the gastrocolic or gastrohepatic ligaments or
penetrates into the greater or lesser omentum without
perforating the visceral peritoneum covering these structures is
coded T2. Any perforation of the visceral peritoneum covering
the gastric ligaments or omentum is classified T3.
M1a Celiac lymph nodes
M1b Other distant metastasis
SMALL INTESTINE
T1 Lamina propria or submucosa
T2 Muscularis propria
T3 Subserosa, non-peritonealized perimuscular tissues
(mesentery, retroperitoneum) = 2 cm
T4 Visceral peritoneum, other organs/structures (including
mesentery, retroperitoneum) > 2 cm
N1 Regional lymph node metastases
M1 Distant metastasis
STOMACH
T1 Lamina propria or submucosa
T2 Muscularis propria or subserosa
T2a – Tumor invades muscularis propria
T2b – Tumor invades subserosa
T3 Penetrates serosa
T4 Adjacent structures
N1 1 - 6 nodes
N2 7 - 15 nodes
N3 > 15 nodes
Extension of tumor along the stomach wall into the duodenum or
esophagus is classified by the greatest depth of invasion at any
of these sites, including the stomach.
M1 Distant metastases
Adjacent structures of the stomach are the spleen, transverse
colon, liver, diaphragm, pancreas, abdominal wall, adrenal
gland, kidney, small intestine, and retroperitoneum.
TREATMENT
BRIEF SUMMARIES OF 6th EDITION CATEGORIES
Surgery is the treatment of choice for stomach cancer, as long as
adequate margins (5-6 cm) around the tumor can be obtained
and regional lymph nodes are removed. Total gastrectomy does
not improve survival, compared to subtotal or partial
gastrectomy.
ESOPHAGUS
T1 Lamina propria or submucosa
T2 Muscularis propria
T3 Adventitia
T4 Adjacent structures
Surgery (Stomach)
(Continued on page 8)
JULY/AUGUST 2004 MONTHLY MEMO
HAPPY FOURTH OF JULY
UGI TRACT CANCER (Cont’d)
Page 8
(Continued from page 7)
Types of Surgery
Key: X = complete * = partial
o = optional
• = see note under procedure
------------Tissue Removed ---------Lesion
Local surgical excision
Includes excision of ulcer, other lesions or stomach
tissue with evidence of tumor
X
Polypectomy
X
Stomach
(Upper)
Stomach Lymph
(Lower) Nodes
Partial/subtotal/hemigastrectomy --upper (proximal)
portion
Includes sleeve resection of stomach
may include part of esophagus
*
X
Antrectomy
X
X
Partial/subtotal/hemigastrectomy
--lower (distal) portion.
Includes sleeve resection of stomach
may include part of duodenum
Gastropylorectomy
Billroth I
includes part of duodenum
Billroth II
includes duodenum
Other
Organs#
•
X
X
•
X
X
X
X
•
X
X
•
Partial/subtotal/hemigastrectomy,
not otherwise specified
Includes sleeve resection of stomach, resection of
portion of stomach, NOS
*/°
*/°
°
°
Total/near total gastrectomy (more than 80%) Includes
resection with pouch left for anastomosis, total
gastrectomy following previous partial
resection for other reason
X
X
X
°
Hofmeister-Finsterer operation
X
X
X
Gastrectomy, not otherwise specified
*/X
*/X
X
°
Gastrectomy (partial/total/radical) with partial/total
removal of other organs
*/X
*/X
X
*
*/X
*/X
Surgery of regional/distant sites/nodes only
# May include spleen, momentum, mesentery, or mesocolon
(Continued on page 9)
JULY/AUGUST 2004 MONTHLY MEMO
HAPPY FOURTH OF JULY
UGI TRACT CANCER (Cont’d)
Page 9
Other Therapies
(Continued from page 8)
Surgery (Esophagus & Small Intestine)
Operative treatment of esophageal cancer carries up to a 40%
mortality rate and 10% five year survival. Surgery is most effective for
esophageal cancers in the distal half. Maintaining nutrition is extremely
important; however, esophageal feeding tubes, colonic interpositioning,
and feeding gastrostomies are each accompanied by high morbidity.
Laser surgery can help to maintain an open passageway for nutrition.
For carcinoid tumors less than 1 cm in diameter, local resection is the
treatment of choice. If the tumor is larger than 1 cm, the resection should
include regional lymph nodes from the mesentery.
TYPES OF SURGERY
------------Tissue Removed ----------
Cryosurgery
Cautery, fulguration
(without specimen)
Tumor
only
Organ
Lymph
Nodes
Other
Organs
SYSTEMIC THERAPY
DRUGS COMMONLY USED FOR TREATING UPPER
GASTROINTESTINAL CANCERS
Chemotherapy for esophageal cancer
*
Combinations using CisPlatinum (under clinical
evaluation)
Examples
Cisplatinum, mitomycin C, bleomycin
Cisplatinum plus 5-FU
Cisplatinum, vindesine, bleomycin
Cisplatinum, methotrexate, bleomycin
*
Laser surgery with
specimen
Radiation therapy is most effective for carcinomas of
the upper third of the esophagus (cervical portion) and
for Stage III and IV cancers. Radiation is also used to
maintain patency of the lumen and to treat metastases.
More recently, there has been research on the benefits
of radiation combined with 5-FU and Mitomycin C
chemotherapy for local control of dysphagia.
Adenocarcinomas of the esophagus are not as
radiosensitive as squamous cell carcinomas.
Gastric cancer does not respond readily to radiation
therapy for cure, although it can be used for palliative
treatment, metastases to bone or brain, or to deter
gastric hemorrhage.
Key: X = complete * = partial
o = optional
= see note under procedure
Tumor
destruction
RADIATION THERAPY
*/X
Excisional biopsy
*
Polypectomy
*
Excision of lesion
*
Partial/simple surgical
removal, primary site
no lymph node dissection
X
Partial/simple surgical
removal, primary site
with lymph node
dissection
X
X
Examples:
FAM (5-FU, adriamycin, mitomycin C)
5-FU plus methyl CCNU
5-FU plus adriamycin
EAP (Etoposide, adriamycin, cisplatin)
FAP (5-FU, adriamycin, cisplatin)
FAB (5-FU, adriamycin, carmustine
*/o
o
Chemotherapy for cancer of small intestine
Debulking procedure
(so stated) with or
without lymph node
dissection
Radical surgery, primary
site
Surgery of regional/
distant sites/nodes only
X
Chemotherapy for stomach cancer
Combinations using 5-FU, adriamycin, mitomycin C,
cisplatin, nitrosoureas (BCNU, CCNU)
Streptozotocin plus 5-FU
Adriamycin plus 5-FU
X
X
o
Hormones (not shown to be effective for esophagus,
stomach or small bowel cancers)
o
Biological Response Modifiers (under clinical evaluation)
Alpha interferon has been tried for metastatic carcinoid
tumor, but the toxicity is significant.
(Continued on page 10)
JULY/AUGUST 2004 MONTHLY MEMO
HAPPY FOURTH OF JULY
UGI TRACT CANCER (Cont’d)
Page 10
Use TX if the primary tumor was excised at another facility
and no information about tumor size is available.
(Continued from page 9)
Keys to Abstracting
The stomach (all sections) is considered a single organ. The
esophagus (entire length) is considered a single organ. The
small intestine is considered three organs: duodenum, jejunum,
ileum.
Gastric ulcers in patients with achlorhydria are malignant until
proven otherwise.
Debulking is surgical removal of as much macroscopic tumor as
possible in the abdomen. The principle behind debulking is to
reduce the size of the largest residual tumor to less than 2.0 cm
in greatest dimension so that the patient's total tumor mass is
minimal. The effectiveness of postoperative adjuvant radiation
and chemotherapy is increased when the tumor burden is
smallest. Also called: tumor reduction surgery, cytoreductive
surgery.
Record circumferential lesion (entire circumference) of the
esophagus as 998 in the field "Size of Tumor."
Record 998 in "Size of Tumor" field if involvement of stomach
is described as 3/4 or more of stomach, diffuse, linitis plastica,
or widespread.
Do not add together the sizes of pieces of tumor removed at
biopsy and at resection. Use the largest size of tumor, even if
this is from the biopsy specimen. If no size is stated, record as
999 in the field "Size of Tumor."
For esophageal cancer, disregard extension within the wall
(intraluminal) to adjacent segments of esophagus and code the
maximum depth of invasion through the esophageal wall or
extra-esophageal spread wherever it occurs.
For stomach cancer, disregard extension within the wall
(intraluminal) to esophagus or duodenum and code the
maximum depth of invasion through the stomach wall or extragastric spread wherever it occurs.
For small bowel cancer, disregard extension within the wall
(intraluminal) to adjacent segments of small intestine and code
the maximum depth of invasion or spread beyond small bowel
wall wherever it occurs.
If a partial resection of the stomach is performed for diagnosis
and a more complete procedure, such as a Billroth II, is done as
cancer-directed surgery, code the more complete surgical
procedure. The surgical code should indicate the status of the
primary organ at the completion of the procedure.
Marie Cranmer, CTR - Sanford
Melissa A. Schuster, CTR - Cape Coral
Jason D. Strader, CTR - West Palm Beach
Daniel P. Vargo, CTR - SW Ranches
JULY/AUGUST 2004 MONTHLY MEMO
HAPPY FOURTH OF JULY
Page 11
EDUCATION AND TRAINING
PRINCIPLES OF ONCOLOGY FOR
CANCER REGISTRY PROFESSIONALS
December 6 - 10, 2004
Bolger Center for Leadership Development
Potomac, Maryland
Registration fee: $695.00*
*The registration fee is reduced for participants who stay at the
conference center.
Principles of Oncology is an intensive five-day training program in cancer registry operations and procedures emphasizing accurate data collection. The training program includes
extensive site-specific, hands-on case abstracting and coding
sessions using both full medical records and abstracts that are
representative of the many situations registrars may face. This
program is endorsed by the National Cancer Registrars Association (NCRA) and the North American Association of Central
Cancer Registries (NAACCR). NAACCR also serves as the fiscal
agent for this program.
Class size will be limited to 25 registrants.
CANCER REGISTRATION & SURVEILLANCE
TRAINING PROGRAMS
2005 CTR EXAM CONTENT
http://www.ctrexam.org/
The content of the 2005 CTR Examinations will be
drawn in part from the publications of several national standard-setting organizations, including:
•
•
•
•
•
International Classification of Diseases for
Oncology 3rd Edition (ICD-O-3);
Facility Oncology Registry Data Standards
"FORDS: Revised for 2004";
AJCC Cancer Staging Manual 6th Edition;
CoC Cancer Program Standards 2004
Collaborative Staging Manual and Coding
Instructions, version 1.0.
The Collaborative Staging (CS) will test on the following data fields and sites.
CS DATA FIELDS:
1. CS Extension
2. CS Lymph nodes
3. CS Metastasis at Diagnosis
The Fullmer Institute is pleased to announce:
•
•
Principles and Practice of Cancer Registration
and Surveillance
- November 1-5, 2004
(and more dates in 2005!)
Advanced Topics in Cancer Registration and
Surveillance
October 18-20, 2004
May 4-6, 2005
August 10-12, 2005
For further information and registration go to:
http://www.fullmerinstitute.org
Specific CS FIELD SITES:
1. Breast
2. Lung
3. Colon Rectal
4. Bladder
5. Kidney
6. Melanoma
7. Ovary
8. Corpus Uteri (Endometrium)
9. Pancreas
10. Thyroid
Please note that Summary Stage 2000 is no longer
tested. Plus, the exam content excludes any clarifications posted in the SEER SINQ and Commission on
Cancer's Inquiry and Response system.
The 2005 Handbook for Candidates will be posted
here in late 2004.
JULY/AUGUST 2004 MONTHLY MEMO
HAPPY FOURTH OF JULY
FLORIDA CANCER DATA SYSTEM
PROJECT DIRECTOR:
Lora Fleming, MD, PhD
Path
Radiation
2,500 ,00 0
ADMINISTRATIVE DIRECTOR:
150,0 00
Jill Mackinnon, CTR
2 ,000 ,00 0
EDITORIAL STAFF:
12 0,0 00
1,500 ,00 0
Mark Rudolph, M.S.
Mayra Alvarez, RHIT, CTR
Melissa K. Williams
9 0,0 00
CONTRIBUTORS:
Betty Fernandez
1,000 ,00 0
6 0,0 00
500 ,00 0
3 0,0 00
0
A ug-03
No v-03
Feb-04
M ay-04
A ug-04
0
Oct 20 0
Dec2 00
Feb200
A p r20 0
Jun2 00
A ug200
66046E
P. O. BOX 016960 (D4-11)
MIAMI, FL 33101